Comprehensive programmes to help reduce substance misuse/mental illness in youth should combine Screening, Brief Intervention, and Referral to Treatment (SBIRT). EMPATHY, an SBIRT programme, was part of a school-based prevention initiative to reduce symptoms of substance misuse in youth in Grades 6-12, along with reducing symptoms of depression, suicidal thinking, and anxiety. To better understand the feasibility of school-based SBIRT, we retrieved perspectives of administrators primarily through interviews. The level of engagement and interest of youth in the programme was high; however, two significant barriers were: (1) the need for parental consent/involvement; and (2) a systemic gap in treatment choices for youth with mild to moderate symptomology. Therapeutic alliance with students was reportedly a significant factor contributing to benefits.